Healthcare Provider Details

I. General information

NPI: 1518598739
Provider Name (Legal Business Name): JOSEPH GUMBRILL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2020
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 S WALKER AVE
OKLAHOMA CITY OK
73139-7026
US

IV. Provider business mailing address

3601 24TH AVE SE APT 7
NORMAN OK
73071-3100
US

V. Phone/Fax

Practice location:
  • Phone: 405-634-4400
  • Fax:
Mailing address:
  • Phone: 580-512-7289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number8526
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: